• Journal of Yeungnam Medical Science
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• v.17 no.2
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• pp.146-154
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• 2000

Background and Purpose: Radioopaque lesions are commonly seen in patients who received thoracic radiotherapy for various kinds of thoracic neoplasm, But therir exact diagnos are sometimes uncertain. Patients and Methods: We examined simple chest radiograph and computed tomogram(CT) of 69 patients who received thoracic radiotherapy for lung cancer and were follow up at least 6 months in Yeungnam University Medical Center. Results: Of the 69 patients. thirty-eight patients showed radioopaque lesions in their chest radiographs except radiation fibrosis; radiation pneumonitis was witnessed in 24 patients. infectious pneumonia in 8 patients, and recurrence in 6 patients. In radiation pneumonitis patients, the pneumonitis occurred usually between 50 to 130 days after receiving radiation therapy, and interval between pneumonitis and fibrosis is 21 to 104 days. Simple chest radiographs of radiation pneumonitis(24 patients) represented ground glass opacities or consolidation in 4 cases(type I, 17%), reticular of reticulonodular opacities in 10 cases(type II, 42%), irregular patchy consolidations in 2 cases( type III, 8%), and consolidation with fibrosis in 8 cases(type IV, 33%), CT represent ground glass opacities or consolidation in 5 cases(type I, 29%), irregular nodular opacities in 3 cases(type II, 19%), irregular opacity beyond radiation fields in 3 cases(type III, 18%), and consolidation with fibrosis in 6 cased(type IV, 35%). The CT of four patients who represented type II on simple chest radiographs reveal type I and III, and CT of two patients with clinical symptoms who had no abnormal finding on simple radiograph revealed type I. Conclusions: In conclusion, computed tomogram is superior to the simple radiograph when trying to understand the pathologic process of radiation pneumonitis and provide confidence in the diagnosis of radiation induced lung disease.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.16 no.1
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• pp.34-41
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• 2016

Adult-onset type II citrullinemia (CTLN2) is characterized by episodes of neurologic symptoms associated with hyperammonemia leading to disorientation, irritability, seizures, and coma. CTLN2 is distinct from classical citrullinemia, which is caused by a mutation of the argininosuccinic acid synthetase (ASS) gene. The serum citrulline level is elevated, while the activity of ASS in liver tissue is decreased. CTLN2 is known to have a poor prognosis if the proper treatment is not taken. We reported a female aged 37 years who developed recurrent attacks of altered consciousness, aberrant behavior, and vomiting. We initially suspected the patient had CTLN2 because of the signs of hyperammonemic encephalopathy, such as altered mentality, memory disturbance, and aberrant behaviors provoked by exercise-induced stress and excessive intravenous amino acid administration. Through her peculiar diet preferences and laboratory findings that included hyperammonemia and citrullinemia, we diagnosed the patient as CTLN2, and SLC25A13 sequencing revealed known compound heterozygous mutations (IVS11+1G>A, c.674C> A). Her parents were heterozygous carriers, and we identified that her older sister had the same mutations. The older sister had not experienced any episodes of hyperammonemia, but she had peculiar diet preferences. The patient and her sister have been well with conservative management. When considering the clinical course of CTLN2, it was meaningful that the older sister could be diagnosed early in an asymptomatic period and that preemptive treatment was employed. Through this case, CTLN2 should be considered in adults who present symptoms of hyperammonemic encephalopathy without a definite etiology. Because of its rare incidence and similar clinical features, CTLN2 is frequently misdiagnosed as hepatic encephalopathy, and it shows a poor prognosis due to the lack of early diagnosis and proper treatment. A high-carbohydrate diet, which is usually used to treat other urea cycle defects, can also exaggerate the clinical course of CTLN2, so proper metabolic screening tests and genetic studies should be performed.

• Pediatric Infection and Vaccine
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• v.10 no.2
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• pp.186-192
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• 2003

Purposes : Recently, acute gastroenteritis broke out among the neonates transferred from postpartum care centers located in Seoul, and Gyeounggi area. Thus, we researched the cause, progress and characters of the disease by analyzing the cases from 9 hospitals in Seoul and Gyeounggi area. Methods : We conducted retrospective study of 33 neonates transferred from postpartum care centers from October 2001 to July 2002 : we divided the neonates into 2 groups. The severe group had any of following 5 conditions : blood pH <7.20, respiratory difficulty, mechanical ventilation, shock, and disseminated intravascular coagulation. And the rest were classified into the moderate group. Results : The severe group was significantly more aged than the moderate group(P= 0.005). Weight loss was significantly severe in the severe group(P=0.0512). In blood gas analysis, bicarbonate was less in the severe group than the moderate group(P=0.032). In the virus examination, rotavirus was detected in 7 cases, and astrovirus was detected in 1 case. In the severe group, 4 neonates were dead. Conclusion : In acute gastroenteritis of neonates, early diagnosis and treatment are important. Thus, the legislation of postpartum care center is needed, and the medical specialists should be stationed in postpartum care center. We assume that the severe group had severe conditions because they were treated comparatively late. However, to find out the cause of the disease and to cope with it, the nationwide epidemiologic study on acute gastrenteritis of neonates is needed.

• Journal of Chest Surgery
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• v.39 no.9 s.266
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• pp.674-680
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• 2006

Background: Acute myocardial infarction (MI) is a life-threatening disease and surgical revascularization plays a major role in selected cases. The purpose of this study is to evaluate the left ventricular contractility improvement by examining the wall motion score index (WMSI) and left ventricular ejection fraction (LVEF) in patients who under-went surgical revascularization under diagnosis of acute MI. Material and Method: From January, 2001 to December, 2004, 149 patients who underwent coronary artery bypass surgery within 2 weeks of acute MI were included. We evaluated pre- and postoperative left ventricular contractility by measuring WMSI and LVEF and examined the associating factors. Result: WMSI decreased from $1.54{\pm}4.30\;to\;1.43{\pm}0.40$ (p<0.001) and LVEF increased from $48.1{\pm}12.2%\;to\;49.7{\pm}12.3%$ after surgery (p=0.009). Off-pump technique, non-Q wave, anterior MI, and surgery within 7 days after MI were favorable factors for LVEF improvement (p=0.046, p=0.006, p=0.003, p=0.005, respectively). Conversely, aforementioned factors were irrelevant with WMSI improvement. For triple vessel disease, complete revascularization was favorable factor for WMSI improvement (p<0.001). Conclusion: Coronary artery by-pass surgery can improve WMSI and LVEF in patients with acute MI. In case of anterior MI with non-Q wave, early surgical revascularization within 7 days may be most beneficial in LVEF improvement. Regarding WMSI, complete revascularization may be essential.

• Journal of the korean academy of Pediatric Dentistry
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• v.33 no.3
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• pp.411-421
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• 2006

In children, during developing occlusion stage, many studies confirm a high prevalence of gingival inflammation. Prevention, early diagnosis and treatment of gingival and periodontal disease is important because by establishing excellent oral hygiene habits in children, the risk of periodontal disease can be on the decrease in adulthood. This study evaluated the gingival conditions of 50 children$(8.5{\pm}3.1years)$ and 20 $adults(26.1{\pm}3.3 years)$ receiving clinical examination and GCF test at the pediatric dentistry of Chonbuk national university hospital in Jeonju, Korea. I estimated children's and adult's gingival states by measuring gingival crevicular fluid(GCF) using Periopaper and $Periotron^{(R)}$ 8000, gingival index, plaque index, DMFT scale. The results were as follows : 1. There are no statistical differences of GCF volume among the groups of the primary dentition, tooth erupting stage, complete eruption stage(p>0.1). But mean value of GCF is highest at the tooth erupting stage. 2. Comparing with adults, children have higher mean value of GCF volume with statistical differences (p<0.001). 3. There is statistically positive relationship between volume of GCF and gingival index (GI), plaque index(PLI) in both adults and children(GI; r=0.394, PLI ; r= 0.642). 4. There is no relationship between GCF volume and dental caries, composite resin treatments (p>0.05). But There is statistically positive relationship between GCF and orthodontic treatments(p<0.001) 5. Primary dentition has higher mean value of DMFT than permanent dentition(p<0.001). But there is no statistical relationship between GCF and DMFT (p>0.1).

• Korean Journal of Adult Nursing
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• v.12 no.2
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• pp.184-195
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• 2000

It has been believed that cancer is an omnious factor threatening the future and life itself. Patients having the disease experience anxiety, fear, feeling of weakness, depression and feelings of uncertainty and hopelessness. Most cancer patients, however, have expectations of possible recovery and a better future, very different from the patients who feel hopeless. Therefore. hope allows people to respond effectively to the fatal disease they have and prevents them from detoriorating physically and spiritually, positively influencing their survival, response to treatment and sense of security. Studies previously performed showed that hope is positively correlated with social and family supports, self-esteem, spiritual well-being, responsive action, health promotion behavior and quality of life. Thus, the study attempted to provide basic information on nursing cancer patients by investigating their levels of hope and determining predictive factors which influence hope. For the study 200 cancer patients in two university hospitals located in Pusan were sampled as subjects. Data were collected for twenty nine days from Feburary 1, 1999 to March 1. Instrumets for the study included 10 items from the self-esteem scale by Rosenberg (1965), 39 hope measurements by Kim and Lee(1965), 16 of the social support scale by Tae(1986) and 16 of the general characteristics scale, all of which totaled 81 items. The data were analyzed using the SPSS program. General characteristics of the investigated based on numbers and percentage. Hope, self-esteem and social support were analyzed using means, minimum, maximum and standard deviation. Relations among the foregoing three factors were analyzed using Pearson' correlation coefficient. Levels of hope in cancer patients were determined using t-test, ANOVA and Scheffe test. Predictive factors influencing hope were investigated using multiple stepwise regression analysis. Results of the study are summarized as follows: 1. An average level of hope was $185.55{\pm}23.39$ points(96 min. and 234 max.) 2. Levels of hope showed a significant difference among them according to sex (t=-3.69, P=.000), age(F=4.714, P=.000), job(F=3.247, P=.008), monthly income (F=6.113, P=.003), treatment charge (F=3.796, P=.011), supportive resources (F=10.554, P=.000), diagnosis(F=2.287, P=.029), perceived health status(F=22.184, P=.000), level of pain(F=3.334, P=.021), religion (F=4.911, P=.001) and religion's effect in life (F=11.706, P=.000), 3. For the subjects, self-esteem and social support were $38.32{\pm}7.21$(13 min, and 50 max.) and $52.97{\pm}8.49$points(28 min, 80 max.). Concerning social support, average levels of family support and medical support were found $35.95{\pm}6.05$(18 min, and 40 max) and $27.02{\pm}4.99$ points(20 min and 40 max). The hope the cancer patients showed significant correlations with self-esteem (r=.588, P=.000), family support(r=.224, p=.001) and medical support(r=.221, P=.002). 4. The five variables related to hope (self-esteem, religion's effect in life, perceived health status, social support and age) accounted for 54.2 percent of the hope level; especially, self-esteem was the highest at 34.6%. As shown in the above results, predictive factors which most influence hope in cancer patients were self-esteem and religion's effect of life. Therefore, nursing interventions to increase self-esteem should be developed. Regarding religion's effects, studies on spiritual aspects should be carried out in a way that contributes to promotion of hope.

• Progress in Medical Physics
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• v.16 no.4
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• pp.207-213
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• 2005

The severity of carotid Intima-media thickness (IMT) is an Independent predictor of atherosclerosis which causes transient cerebral ischemia, stroke, and coronary events such as myocardial Infarction. The IMT consists of Intima thickness (IT) and media thickness (MT). However, the Individual clinical significance of IT and MT has not been well studied. We devised a method of measuring IT, MT, and IMT using B-mode ultrasound Image processing technique for the diagnosis of atherosclerosis. To inspect the clinical significance of IT, MT, and IMT, one hundred forty-four consecutive patients (mean age; 57 years old, 72 males) were underwent common carotid artery scanning using high-resolution ultrasound. Results showed that, the IT (p<0.05), MT (p<0.05) as well as IMT (p<0.01) of patients with atherosclerotic disease were significantly thicker than that of the patients without atherosclerotic disease. Patients with hyperiension showed significantly thicker IT (p<0.01), MT (p<0.001), and IMT (p<0.001). However, only IT was thicker in patients with smoking (p<0.01). The IT (r=0.374, p=0.001), MT (r=0.433, p=0.000), and IMT (r=0.479, p=0.000) showed positive correlation with age. The coefficients of determination ($r^2$) were estimated to be $92.4\%$ for IMT and MT, $49.1\%$ for IMT and IT, and $27.4\%$ for IT and MT. This result suggests that the Intima layer of the carotid artery has a different physiology with the media layer.

• The Korean Journal of Nuclear Medicine
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• v.36 no.3
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• pp.177-184
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• 2002

Purpose: Ultrasonography and $^{99m}-Tc-MIBI$ scintimammography were validated as useful diagnostic tools for primary breast cancer. However, ultrasound has the problem of low specificity. We compared the diagnostic usefulness of ultrasound with $^{99m}-Tc-MIBI$ scintimammography in the diagnosis of breast cancer. Materials and Methods: This study included 174 patients who had ultrasound and $^{99m}-Tc-MIBI$ scintimammography peformed on breast masses from 1999 to 2000. The pathologic results were obtained by surgery or FNAB. Results: Among the 174 patients, malignant breast disease numbered 117 and benign breast disease numbered 57. Ultrasound revealed 88 TP, 9 FN, 8 FP, 34 TN, and 35 indeterminate cases. $^{99m}-Tc-MIBI$ scintimammography revealed 91 TP, 25 FN, 9 FP, and 48 TN. The sensitivity, specificity, positive predictive value, and negative predictive value of Ultrasound were 66.7%, 44.2%, 67.2%, and 43.6% respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of $^{99m}-Tc-MIBI$ scintimammography were 77.8%, 84.2%, 91%, and 64.9% respectively. Among the 35 indeterminate ultrasound cases, $^{99m}-Tc-MIBI$ scintimammography revealed 13 TP, 15 TN, and 7 FP Conclusion: $^{99m}-Tc-MIBI$ Scintimammography was more sensitive and specific than ultrasound for the detection of primary breast cancer and provided more useful information in cases of indeterminate ultrasound findings.

• The Korean Journal of Nuclear Medicine
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• v.23 no.2
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• pp.175-181
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• 1989

Visual assessment of regional wall motion abnormality (RWMA) by gated blood pol scan (GBPS) serves as an useful parameter in the diagnosis, functional evaluation, and follow up in various clinical settings, but are still subject to some inherent limitations. On important problem may be the interobserver as well as intraobsever variation that may well be present due to the subjective nature of the interpretations. This study was carried out to determine the reliability and reproducibility of visual assessments made in GBPSs, and to observe the degree to which the results would be influenced by observer variation. Fifty two patients with coronary heart disease had resting GBPS and contrast ventriculography within 4 days appall. Contrast ventriculography-showed normal wall motion in 6 patients and the remaining 46 had RWMA in one or more segments. The anterior and left anterolateral views of all 52 GBPSs were analyzed by three independent observers, who selected from 5 scales, their level of confidence that there was RWMA in that segment. Reciever operating characteristic (ROC) curves for each analysis was plotted and the area under the curve $(\theta)$ was used as a parameter representing each observer's performance in his interpretations. The findings of contrast ventriculographies were used as the standard for RWMA. The apical and inferoapical segments showed the best correlation with contrast ventriculography ($\theta=0.90-0.94$, 0.81-0.94, respectively), and the inferior wall showed the poorest correlation $(\theta=0.70-0.74)$. The interpretations of the inferior, septal, apical, and posteroinferior, segments showed no difference between the observers, but there was significantly better performance in assessment by observer A compared to that by B or C for the anterolateral segments ($\theta=0.87$, 0.78, 0.76, respectively. p<0.01 for A vs B, p<0.05 for A vs C), as well as when all segments were considered altogether ($\theta=0.88$, 0.83, 0.82, respectively. both p<0.05). This was also true for the infero-apical segment between A and C ($\theta=0.09$, 0.81, p<0.05). The intraobserver variation, however, did not appear significant, with only the inferior segment for observer B showing any significant difference when observer A and B repeated the analysis 10 days latter. There was no difference in assessing dyskinesia, with all observers showing a high performance ($\theta=0.98$, 0.87, 0.97, respectively). The visual assessment of left ventricular ejection fraction by all three observers correlated well with the calculated value from a semiautomated method (Spearman's r = 0.91, 0.83, 0.83. p<0.01, p<0.05, p < 0.05). The assessment of LV and RV size also correlated well between the three observers (Kendall's w = 0.80, 0.51, p<0.01 for both left and right ventricles). The above findings suggest that RWMA visually assessed by GBPS correlates well with that done by contrast ventriculography. And although the observer's experience or skill may influence the results in certain segments, visual analysis of GBPS may serve as a reliable and reproducible means for evaluating ventricular function.

• The Korean Journal of Nuclear Medicine
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• v.33 no.1
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• pp.40-48
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• 1999

Purpose: The sensitivity of ST-depression in the electrocardiogram during exercise is influenced by the level of efforts. However, unlike the prevalence of ST-depression on exercise ECG, the degree of exercise is reported to do not influence the diagnostic ability of myocardial perfusion scan. Furthermore, the relation between the prevalence of myocardial ischemia and effort is still controversial. We evaluated the effect of the degree of exercise on the ability of SPECT imaging to detect coronary artery stenosis. Materials and Methods: The patient population was comprised of 111 patients (73 men and 38 women, mean age 56 years) who underwent an exercise test in conjunction with Tc-99m MIBI and cardiac catheterization within 3 months apart each other. The degree of exercise was classified into four groups according to the percentage of maximal predicted heart rate. The sensitivity and specificity was compared between each group. Results: The overall diagnostic sensitivity was significantly higher with Tc-99m MIBI SPECT than exercise ECG. The specificity was not significantly different between two tests. Sensitivity and specificity of Tc-99m MIBI was not different between four groups. Sensitivity for individual coronary stenosis seemed to be lower in subjects who had premature termination of exercise due to early appearance of ST depression. Conclusion: These results suggest that the overall diagnostic sensitivity of Tc-99m MIBI myocardial perfusion SPECT is not significantly affected by the degree of exercise in stable patients undergoing symptom-limited treadmill exercise testing. Myocardial perfusion SPECT imaging should be added to routine exercise stress testing for the detection of coronary artery disease.